A Narrative Review of Microsporidial Infections of the Cornea

Moshirfar, Majid; Somani, Shaan N.; Shmunes, Kathryn M.; Espandar, Ladan; Gokhale, Nikhil S; Ronquillo, Yasmyne C; Hoopes, Phillip C

doi:10.1007/s40123-020-00243-z

Cited by 28 publications

(26 citation statements)

References 72 publications

(165 reference statements)

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“…Microsporidial keratitis represents another type of parasitic IK that accounts for ~0.4% cases of all IK [ 84 ]. It is mainly observed in Asian countries and may manifest as superficial keratoconjunctivitis or stromal keratitis.…”

Section: Causative Microorganismsmentioning

confidence: 99%

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Infectious keratitis: an update on epidemiology, causative microorganisms, risk factors, and antimicrobial resistance

Ting

Deshmukh

et al. 2021

Eye

208

243

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Corneal opacity is the 5th leading cause of blindness and visual impairment globally, affecting ~6 million of the world population. In addition, it is responsible for 1.5–2.0 million new cases of monocular blindness per year, highlighting an ongoing uncurbed burden on human health. Among all aetiologies such as infection, trauma, inflammation, degeneration and nutritional deficiency, infectious keratitis (IK) represents the leading cause of corneal blindness in both developed and developing countries, with an estimated incidence ranging from 2.5 to 799 per 100,000 population-year. IK can be caused by a wide range of microorganisms, including bacteria, fungi, virus, parasites and polymicrobial infection. Subject to the geographical and temporal variations, bacteria and fungi have been shown to be the most common causative microorganisms for corneal infection. Although viral and Acanthamoeba keratitis are less common, they represent important causes for corneal blindness in the developed countries. Contact lens wear, trauma, ocular surface diseases, lid diseases, and post-ocular surgery have been shown to be the major risk factors for IK. Broad-spectrum topical antimicrobial treatment is the current mainstay of treatment for IK, though its effectiveness is being challenged by the emergence of antimicrobial resistance, including multidrug resistance, in some parts of the world. In this review, we aim to provide an updated review on IK, encompassing the epidemiology, causative microorganisms, major risk factors and the impact of antimicrobial resistance.

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Section: Causative Microorganismsmentioning

confidence: 99%

“…It is mainly observed in Asian countries and may manifest as superficial keratoconjunctivitis or stromal keratitis. It is commonly associated with ocular trauma, exposure to contaminated water/soil, and potentially acquired immunodeficiency syndrome [ 84 , 85 ].…”

Section: Causative Microorganismsmentioning

confidence: 99%

Infectious keratitis: an update on epidemiology, causative microorganisms, risk factors, and antimicrobial resistance

Ting

Deshmukh

et al. 2021

Eye

208

243

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“…Light microscopy from conjunctival swabs of these organisms demonstrates myriad small (2.0 x 1.0-μm), round-oval microsporidial organisms in the cytoplasm of epithelial cells that stain positively with modified acid-fast and Giemsa methods [ 9 , 11 ]. However, the ocular infection can also be identified on slit-lamp examination by the classic appearance of coarse, multi-focal, raised epithelial or subepithelial infiltrates [ 6 ]. In fact, this led to one limitation in our case series.…”

Section: Discussionmentioning

confidence: 99%

“…Transmission electron microscopy (TEM) has long been considered to be the gold standard for the identification of microsporidia; however, it has fallen out of favor due to its time-consuming nature and lower relative sensitivity [ 6 , 7 ]. Diagnosis and confirmation techniques have undergone diversification over the years, ranging from the conventional staining (Gram stain and modified acid-fast stains) of the specimen and the usage of light microscopy to sequencing with polymerase chain reaction (PCR) and metagenomic deep sequencing (MDS) [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

Microsporidial Keratitis Related to Water Exposure: A Case Series

Huang¹,

Cho²,

Bertram³

2021

Cureus

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The objective of this retrospective study was to present a series of cases involving the rare ocular disease of microsporidia keratitis treated at a private practice clinic and describe the details regarding specific water exposure, clinical course, voriconazole treatment, and increased prevalence of this infection in Augusta, Georgia, USA. Our analysis was based on the accumulated data from all patients (n=15) diagnosed with microsporidia keratitis at our private practice clinic; the clinical course of three cases is discussed in detail in this article. Specific environmental exposures were documented in 10 patients. All patients self-reported that they had no acquired immunodeficiency. In all cases, patients had complete resolution of active symptoms after receiving treatment with 1-2% topical voriconazole, with an approximate average primary treatment duration of 40.1 ± 17.1 days (median: 40 days, range: 14-70 days). None of the patients reported any clinically significant adverse effects from therapy. There have been increasing reports about this emerging infectious pathogen, particularly in Asia. However, there is limited data in the literature on the etiology, pathogenesis, and treatment of microsporidia-caused ophthalmic diseases. In this case series, we highlight the strong correlation of our patients' condition with specific types of water exposure in the USA as well as the complete resolution of active disease in all our patients as a result of monotherapy with topical voriconazole.

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“…Attouchi, 2010; Moshirfar et al, 2020). Enterocytozoon bieneusi is responsible for more than 90% cases of microsporidiosis in humans (Matos et al, 2012).…”

Section: Accepted Articlementioning

confidence: 99%

A global view on fungal infections in humans and animals: opportunistic infections and microsporidioses

et al. 2021

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After cardiovascular diseases, infectious diseases are the second most common cause of death worldwide. Although these infections are caused mainly by viruses or bacteria, a systematically growing prevalence of human and animal opportunistic fungal infections is noticeable worldwide. More attention is being paid to this problem, especially due to the growing frequency of recalcitrant and recurrent mycoses. The latter are classically divided into superficial, which are the most common type, subcutaneous, and systemic. This work discusses opportunistic fungal pathogens without proven horizontal transmission between different animal species including humans and microsporidia as spore-forming unicellular parasites related to fungi; however, with a yet undetermined taxonomic position. The review also mentions etiological agents, risk factors, epidemiology, geographical distribution, and finally symptoms characteristic for individual disease entities. This paper provides insight into fungal infections from a global perspective and Accepted Article This article is protected by copyright. All rights reserved simultaneously draws attention to emerging pathogens, whose prevalence is continuously increasing. Finally, this work also takes into consideration the correct nomenclature of fungal disease entities and the importance of secondary metabolites in the pathogenesis of fungal infections.

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A Narrative Review of Microsporidial Infections of the Cornea

Cited by 28 publications

References 72 publications

Infectious keratitis: an update on epidemiology, causative microorganisms, risk factors, and antimicrobial resistance

Infectious keratitis: an update on epidemiology, causative microorganisms, risk factors, and antimicrobial resistance

Microsporidial Keratitis Related to Water Exposure: A Case Series

A global view on fungal infections in humans and animals: opportunistic infections and microsporidioses

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